Which is the best vasoconstrictor in shock ? Dopamine or Norepinephrine ?

Vaso constrictors are the mainstay drugs in the management of shock syndrome. While ,the ultimate outcome depends on the primary cause for shock, these vaso- constrictors have a critical role in sustaining life , till the organ function is recovered.

The physicians world over, differ in their choice of vasoconstrictor support .They are almost divided equally in their usage between dopamine and norepinephrine .

Surprisingly, there has been no one to one comparison trial till this study in 2010 .This trial is called SOAP 2 published from Brussels , BELGIUM .It compared the usage of these two drugs in variety of shock syndromes. It favors norepinephrine use , that includes cardiogenic shock as well.

The disadvantages of dopamine noted in this trial was

Increased risk of arrhythmias

Increased rate of death in cardiogenic shock

The implication of this trial may force the ACC/AHA guidelines , which advices dopamine as the first choice in shock syndromes especially in cardiogenic cause.